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Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis

机译:认知和行为干预改善学龄儿童和青少年的睡眠:系统评价和荟萃分析

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Study Objectives:Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents.Methods:In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy.Results:After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (9.31 minutes, P = .007) and actigraphy (19.48 minutes, P .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries 15.85 minutes (P = .01) and actigraphy 23.67 minutes (P .0001). At follow-up, the effects on wake after sleep onset from ratings (14.41 minutes, P = .001) and actigraphy (7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated.Conclusions:Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.
机译:研究目标:睡眠问题在儿童和青少年中很常见,并且可以加重合并症。这项荟萃分析研究了随机对照试验对学龄儿童和青少年的认知和行为睡眠干预(有四个或更多治疗疗程)的效果。方法:在系统的文献检索中,确定了六项随机对照试验(n = 528;平均年龄= 14.6岁;女性= 63%)报告的总睡眠时间(TST),睡眠发作潜伏期(SOL),睡眠发作后苏醒以及根据评分和书法记录的白天嗜睡情况。在自我报告的TST上观察到,但用笔法测量时,观察到有利于干预组的效果(+11.47分钟,P = 0.05)。根据睡眠日记(9.31分钟,P = .007)和活动记录(19.48分钟,P .0001),干预后干预组的SOL较对照组降低。效果大小从小到大。睡眠发作或白天嗜睡后未发现对苏醒的影响。来自四项研究的短期(4至8周)随访数据表明对SOL保持了积极的影响:睡眠日记15.85分钟(P = 0.01)和书法检查23.67分钟(P .0001)。在随访中,从评分(14.41分钟,P = .001)和书法(7.54分钟,P = .01)开始,入睡后对苏醒的影响是显着的,有利于干预组(中等至大影响量)。结论:认知和行为睡眠干预措施可改善学龄儿童和青少年的睡眠。但是,由于治疗方案不均一且偏倚风险很高,因此应谨慎解释结果。需要进行大量严格的测试。

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